Beit Fann Summer Camp Registration Form
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Child's Gender
*
Please Select
Male
Female
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Are there any specific medical or health conditions that we should know about? incl. allergies and dietary requirements
*
Please Select
Yes
No
Please provide further information
*
Please select the dates your child will attend the summer camp:
*
I give permission to Beit Fann, and/or parties designated by Beit Fann to photograph/video my child and use such photograph(s)/video(s) in all forms of media, for any and all promotional purposes including advertising, display, audiovisual, exhibition or editorial use.
*
Agree
Disagree
Submit
Should be Empty: